Læknablaðið : fylgirit - 15.06.2002, Blaðsíða 31

POSTERS / ICELAND 2002: EMERGENCY MEDICINE BETWEEN CONTINENTS
the availability and cost of activated charcoal and ipecac syrup.
When available, a hospital outpatient pharmacy was also included.
Results: Of the 269 pharmacies surveyed, (100% response rate),
89% had ipecac syrup in stock and only 12% had activated
charcoal. Of the pharmacies that did not have activated charcoal in
stock, only 51% could order it. When available, the average order
time for AC was one day. AC was significantly more expensive
than ipecac syrup with average costs of $8.00 and $2.19 respectively.
Conclusion: Recent recommendations for pre-hospital gastric decon-
tamination are trending toward activated charcoal replacing ipecac
syrup. We have identified pharmacy availability and cost as two
present barriers to more widespread use of AC. While ipecac syrup
remains widely available and affordable, 89% of Pennsylvania phar-
macies did not stock gastric decontamination forms of AC and the
average cost was over three times more expensive than ipecac syrup.
P 42 - Pediatric Emergency Medicine
Pain management in pediatric soft tissue injuries
Villanueva TMC
Medical College of Philadelphia - Hahnemann University Hospitals and St.
Christopher's Children's Hospital of Philadelphia, United States
Objective: To determine whether pain management in pediatric
soft tissue injuries resulting in a fracture is affected by the presence
of a gross deformity (GD) being noted by the triage nurse (RN)
and/or the physician (MD/DO).
Methods: fn a retrospective chart review of all pediatric patients
presenting to a children’s Emergency Center over a three-month
period (04/01-06/01), data was collected for all patients with a soft
tissue injury resulting in a fracture. Abstracted data included: date,
sex, triage time, time to MD/DO evaluation, time, type and route of
pain medication given, and whether a GD was noted by MD/DO, RN
or both. Data are means ± standard deviation (std dev) or percents.
Rcsults: There were 173 data sets (62% male, 38% female: 26%
GD, 74% no GD). The average (ave) age was 8.3 years (range 1-
18). Males with GD (68.2%) predominated versus females (31.8%).
Patients with a GD had an ave time until MD/DO evaluation of
46.32 minutes (min) (std dev 50.38) and until pain medication given
of 58.89 min (std dev 53.7). Of the patients with a documented GD,
9% received a MD/DO evaluation without pain medication. 27%
of patients with a documented GD received no pain medication
from the emergency center staff. Patients documented to have a
GD by the MD/DO had an ave time until medical evaluation of
33.375 min (std dev 40.77) and until pain medication given of 54.25
min (std dev 60.9). Patients with a GD documented by the RN had
an ave time until medical evaluation of 83.89 min (std dev 45.74)
and until medication given of 87.5 min (std dev 66.14). Patients
with a GD documented by the MD/DO and RN had an ave time
until medical evaluation of 37.03 min (std dev 49.94) and until
medication given of 50.307 min (std dev 44.487). Patients without a
GD had an ave time until medical evaluation of 92.707 min (std dev
53.97) and until medication given of 104.54 min (std dev 89.6). 62%
of patients without GD received no pain medications. Patients with
a documented GD and pain medication given, 59.1% received a
narcotic and 40.9% a non-steroidal anti-inflammatory drug
(NSAID). Patients with no GD and pain medication given, 31.25%
received a narcotic and 68.75% a NSAID.
Conclusion: Pediatric patients with a documented GD received
expedient care and were more likely to receive an analgesic: the
analgesic most commonly prescribed was a narcotic. These
elements were more optimally available if both the RN and the
MD/DO documented the GD.
P 43 - Pediatric Emergency Medicine
Bulging fontanel: an unusual presentation for influenza A
Klucar-Stoudt A
St. Christopher's Hospital for Children - Medical College of PA - Hahnemann
University Hospitals. United States
Objective: To present a case series of two patients who presented to
a pediatric emergency center with a bulging fontanel and physical
findings consistent with the bacterial meningitis but diagnosed with
influenza A.
Case 1: A 6mo old infant presented to the Pediatric Emergency
Department after acute onset of fever and head swelling. Vital signs
included: rectal temperature - 39.8 C, heart rate - 160, respiratory
rate - 32, and pulse ox. - 99%. Upon general inspection, the infant
was ill appearing with a bulging fontanel. Pertinent exam findings:
clear rhinorrhea, lungs clear without retractions, and no exanthem.
Labs were obtained followed by lumbar puncture (LP) and
Ceftriaxone administration. CBC revealed a WBC of 6.8 with 63.4%
neutrophils and 22.8 % lymphocytes. Serum studies revealed a
glucose of 89 and acidosis - bicarbonate 16. LP results noted a gram
stain without organisms or WBC'S, and a cell count of 2 WBC's and
0 RBC's. The patient was admitted on antibiotics for treatment of
presumptive meningitis. Viral nasopharyngeal washings (VNPW)
were obtained for RSV antigen detection, Adenovirus direct
fluorescent antibody screen and Influenza A and B antigen detection
panel. The influenza A antigen detection was positive. The child was
discharged home the next day with a diagnosis of Influenza A.
Case 2: A 5mo old infant presented to the Pediatric Emergency
Department with a one day history of cough and fever. Vital signs
included: rectal temperature - 38.2 C, heart rate - 160, respiratory
rate - 40, and pulse ox. -100%. Upon general inspection, the infant
was inconsolable with a bulging fontanel. Pertinent exam findings:
occasional inspiratory stridor, barky cough, crusted nares, rhonchi
bilaterally without retractions, and no exanthem. Labs were ob-
tained followed by LP, Ceftriaxone and Vancomycin administra-
tion. CBC revealed a WBC of 7.2 with 38% neutrophils, 2% bands,
and 50% lymphocytes. Serum glucose was 83. The CSF results
were as follows: gram stain without organisms or WBC's, cell count
with 1 WBC and 0 RBC's. The patient was admitted on antibiotics
for treatment of presumptive meningitis. VNPW were obtained.
The influenza A antigen detection was positive. The child was
discharged home the next day with a diagnosis of influenza A.
Conclusion: Bacterial meningitis, especially in children <12 months
of age, is more frequently related to the presence of a bulging
fontanel and irritability. Upon reviewing the current pediatric
literature, there have been no documented case reports of children
presenting with bulging fontanels and the diagnosis of Influenza A.
In both patients, the workup for bacterial meningitis was negative
despite their history and physical findings. Because emergency
physicians do not routinely screen for influenza in the workup of
meningitis could this physical finding coupled with fever and
Læknablaðið/Fylgirit 45 2002/88 31